Here and there: North Carolina’s approach to virtual medical care    

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During COVID-19, limited building occupancies, social-distancing regulations and heightened sanitation standards are making virtual doctor appointments increasingly common. No crowded waiting rooms, no swapping oxygen with strangers; just laptop-to-laptop from the kitchen counter.

The rise in virtual medical care has forced health care systems, patients, and billing and insurance companies to evolve — and quickly.

Mission Hospital in Asheville is the flagship of a six-hospital system and care network that spans across much of western North Carolina. Telehealth, virtual clinics and video visits are a mouse-click away.

“Last year, there were more than 51,000 visits across all telehealth modalities at Mission Health across western North Carolina,” says Amy Roberts, executive director of Mission Health Telehealth. “This number includes provider video visits (with the patient at home connecting to providers), an online Virtual Clinic and hospital hub telehealth visits.”

In February, the N.C. Department of Health and Human Services presented a 14-page guide  called a Telehealth Playbook, which included suggestions for operating costs of virtual visits, tips for communicating with patients, monitoring conditions, working with vendors, technical assistance, dealing with hearing impaired patients, behavioral health issues, even teledentistry.

The guide defines telehealth as “the use of electronic information and telecommunication technologies to support distance clinical health care, patient and professional health-related education, public health and health administration.” Roberts says the concept of remote care is becoming more commonplace, not just a necessity because of COVID-19.

“We believe that patients will still want a hybrid approach to health care that will include in-person and telehealth visits where appropriate,” she says. “We are on pace to have double the volume of telehealth visits in 2021 compared with 2019.”

Cost is a factor. Mission’s Virtual Clinic is $25 per visit, regardless of insurance — or lack thereof. “Other [virtual] visits are covered by insurance similar to in-person visits,” Roberts says.

To address rural-access concerns, the Office of Rural Health & Community in Raleigh, provides funding, training and assistance in providing access to underserved communities. In fiscal year 2019, the ORH spent $32.8 million in state, federal and philanthropic funds and has more than 300 contracts to increase access in rural areas, according to the NCDHHS. 

The department has established  the North Carolina Area Health Education Center program, which was initially developed to address concerns with the supply, distribution, and retention of health care providers in rural areas. NCAHEC’s reach includes a program office, nine regional centers, and the Duke AHEC program office at the Duke School of Medicine. 

Video visits, of course, have limitations. The patient and physician literally see only what’s on the screen, not the whole picture. But Roberts says the program will continue to adjust as pandemic conditions change.

“We were planning on initiating video visits directly to patient homes prior to COVID last year for only follow-up visits before and after surgery,” Roberts says. “After COVID hit, we launched video visits for our physician practices. We have been able to adapt to patient needs and capabilities, connecting on multiple telehealth platforms to multiple locations and launching a digital chatbot to help inform and recommend different telehealth options based on the patient’s immediate need.”

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